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Mental health block > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

LOs for session

A
  • Some understanding of basic psychopharmacology and their application to treatment of different disorders
  • Understand the basic presentations, aetiology, epidemiology and intial management of schizophrenia, bipolar disorder, depressino and anxiety
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2
Q

Classic monoamine hypothesis of depression

A

if the “normal” amount of monoamine neurotransmitter activity becomes reduced, depleted or dysfunctional for some reason, depression may ensue.

Deficient monoamine —> depression

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3
Q

Monoamine receptor hypothesis of depression

A

Extends the classic monoamine hypothesis of depression.

Deficient activity of monoamine NT’s causes up regulation of postsynaptic monoamine NT receptors. Therefore a smaller proportion of receptors are being activated which is communicated as fewer NTs.

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4
Q

5 classes of antidepressants

A

TCA= Tricyclic Antidepressant

SSRI= Selective Serotonine Reuptake Inhibitor

SNRI= Serotonine/ Noradrenaline Reuptake Inhibitor

NaSSA= Noradrenaline and Specific Serotinergic Antidepressant

MAOI- MonoAmine Oxidease Inhibitor

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5
Q

What do Tricyclic Antidepressants do

A
  • block Serotonine and Noradrenaline re-uptake
  • increasing noradregenergic and serotinergic
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6
Q

What do SSRI’s do?

A
  • block serotonin re-uptake
  • increasing serotinergic neurotransmission
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7
Q

What do MAOI’s do?

A
  • Block enzymatic breakdown of noradrenaline, serotonine, dopamine and tyramine
  • increasing neurotransmission
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8
Q

What do NaSSAs do

A

Block pre-synaptic alpha2-adrenoceptors

increasing noradrenergic and serotinergic neurotransmission

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9
Q

Examples and advantages/disadvantages of TCA+related

Of note

A
  • Amitripyline
  • Lofepramine
  • Trazodone

TCA’s are second line treatment for depression. Strong anti-cholinergic effects therefore:

  • Urinary retention
  • drowsiness
  • blurred vision
  • constipation
  • dry mouth

Toxic in overdose

Highly cardiotoxic

  • Quicker onset than SSRIs?
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10
Q

Examples and advantages/disadvantages of SSRI

Of note

A
  • Fluoxetine
  • Sertraline
  • Citalopram
  • Escitalopram
  • Safer in CHD and overdose
  • GI upset
  • anxiety and agitation
  • QT interval prolongation (citalopram)
  • sexual dysfunction
  • hyponatraemia
  • gastric ulcer
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11
Q

Examples and advantages/disadvantages of SNRIs

A
  • Venlafaxine
  • Duloxetine
  • Non-sedating
  • Toxic in overdose
  • Sexual dysfunction
  • Raise BP at higher doses
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12
Q

Examples and advantages/disadvantages of NaSSA

of note

A
  • mirtazapine
  • safer in overdose
  • weight gain
  • sedation

more sedating at lower doses

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13
Q

Examples and advantages/disadvantages of MAOIs

A
  • Phenelzine
  • Tranylcypromine
  • Interaction with foods
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14
Q

Others Examples and advantages/disadvantages of

A
  • Agomelatine
  • Vortioexetine

Both licensed for major depression only

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15
Q

cautions with tricyclics

A
  • contraindicated in patients with previous heart disease
  • can exacerbate schizophrenia
  • may exacerbate long QT syndrome
  • use with caution in pregnancy and breastfeeding
  • may alter blood glucose in T1 and 2 DM
  • may precipitate urinary retention so avoid in men with enlarged prostates
  • avoid in those with liver damage
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16
Q

All antidepressants are associated with an increased risk of:

A
  1. suicidal thoughts and ideation during the first few weeks of treatment
  2. hyponatraemia due to inappropriate secretion of ADH (particularly in elderly people with SSRIs)
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17
Q

Other indications for antidepressants

A
  • anxiety disorders
  • OCD
  • panic disorders
  • Eating disorders
  • Neuropathic pain
  • Migraine prophylaxis
  • Nocturnal enuresis
18
Q

cautions with SSRIs

A
  • should be omitted in mania
  • used with caution in children and adolescents
  • sertraline best for patients wit hischaemic heart disease
19
Q

cautions with SNRIs

A

contraindicated in those with a histroy of heart disease and high BP

20
Q

What are the 4 dopamine pathways in the brain

what does an increase in dopamine cause?

what does a lack of dopamine cause?

A
  1. nigrostriatal pathway
  2. mesolimbic pathway
  3. mesocortical pathway
  4. tuberoinfundibular pathway

Increase in dopamine causes positive symptoms for schizophrenia

Decrese causes negative symptoms and cogmnitive symptoms

21
Q

Examples of 1st gen antipsychotics oral and depot (IM- usually into the glute or thigh)

A

Oral

  • Haloperidol
  • Sulpiride
  • Pimozide

Depot

  • Haloperidol
  • Fluphenazine
  • Flupentixol
22
Q

Examples of oral and LAI (long acting injectible///// depot) 2nd gen antipsychotics

A

Oral

  • Amisulpride
  • Clozapine
  • Lurasidone

LAIs

  • Olanzapine
  • Risperidone
  • Paliperidone
23
Q

Antipsychotics

First gen

  • typically acts on what receptor
  • are selective for which of the pathways?

Second gen

  • are also known by which name
  • act on which receptors
    *
A

first gen

  • act predominantly by blocking DOPAMINE D2 receptors
  • are not selective for any of the 4 dopamine pathways in the brain, therefore causing a range of side-effects e.g., EPSE, elevated prolactin

Second gen

  • atypical antipsychotics
  • act on a range of receptors inclulding SEROTONINE receptors
  • most distict clinical profiles, particulalry in regard to side-effects
24
Q

what is the first line antipsychotic of choice

A
  • atypical (2nd gen) antipsychotic which is risperidone
  • clozapine is recommended to children and adolescents who have tried 2 other antipsychotics already
  • sedatives like lorazepam may be used if there is acute behavioural disturbance in the presentation of schizophrenia but is not first line and wont treat psychosis
25
Q

clozapine

  • how effective of an antipsychotic is it?
  • what are some notable side effects?
  • there is regular testing for which of its side effects?
  • Fatalaties from which side effect?
A

The most effective antipsychotic

  1. hyperprolactinaemia (stimulated by dopamine receptor– risperidone– in men causes gynaecomastia, loss of libido, galactorrhoea and erectile dysfunction, in women causes galactorrhea and sxual dysfunction)
  2. hypersalivation
  3. hyperthermia
  4. tachycardia
  5. constipation
  6. seizures
  7. myocarditis
  8. agranulocytosis (produce too few neutrophils)

Mandatory blood monitoring for neutropaenia and agranulocytosis

Fatalities from bowel impaction

26
Q

which antipsychotic causes a lot less prolactinaemia so is a good alterntive or adjunct?

A

aripiprazole

27
Q

Antipsychotics to note

  • ECG’s
  • blood monitoring
A
  • A baseline ECG is recommended before initiating any antipsychotics and continued monitoring is advised, including regular repeat ECG’s at dose changes and at regular review (u&eS, fbc, LIPID PROFILE, FASTING GLUCOSE, hbalc)
  • Clozapine is subject to mandatory blood monitoring in the UK and is only available from specialist prescribers
28
Q

Anti-muscarinics

what are they used for and examples of anti-muscarinics

A

antipsychotic-induced parkonsinism/ EPSE (extrapyramidal movement disorders due to antipsychotics)

  • procyclidine
  • trihexyphenidyl
  • orphenadrine

hypersalivation

  • hyascine hydrobromide
29
Q

MOOD STABILISERS

  • largely which disorders are these drugs for?
  • Acute phase mood stabilisers?
  • long term mood stabilisers?
A

bipolar depression and mania

Acute phase

  • benzodiazepines- e.g., lorazepam
  • Antipsychotics- e.g., quetapine, aresenapine

Mood stabilisers

  • Carbamazepine
  • Valproate
  • lamotrigine
  • lithium
30
Q

Lithium

  • what kind of drug is it
  • what time range is it used for
  • how large is its therapeutic index
  • how closely is it monitored
  • signs of toxicity?
  • negative interactions?
A

most effective long term mood stabiliser

narrow therapeutic index

therefore close monitoring required (look at eGFR, U&Es, TFTs, weight, calcium baselines)

signs of toxicity:

  • loss of appetite
  • nausea
  • diarrhoea
  • muscle weakness/ twitching
  • drowsiness
  • coarse tremor
  • ataxia

Interactions with NSAIDs, thiazide diuretics and ACE inhibitors

31
Q

Hypnotics

what are the 3 main classes and examples

A

benzodiazepines

  • temazepam (short acting)
  • act as receptors associated with GABA (inhibitory transmitter)
  • High potential for dependancy

Z drugs

  • Zaleplon, zolpidem, zoplicone

Others

Promethazane (antihistamine)

Melatonin (pineal hormone)

32
Q

Anxiolytics

2 main groups give examples and how long each example lasts for

A

Benzodiazepines

Diazepam

  • Long lasting

Lorazepam

  • Short acting

Chlordiazepoxide

  • Alcohol detpxification

Others

Buspirone

  • Low potential for dependancy

Pregablin

  • Antiepileptic, licensed for Generalised Anxiety Disorder and neuropathic pain
33
Q

Drugs for dementia

Alzheimer’s- class and 1st+2nd line examples side effects

Severe alzheimer’s- examples

A

Mild to moderate alzheimer’s- acetylcholinesterase inhibitors

  • Donepezil- 1st line
  • Rivastigmine/ galantamine- 2nd line

loss of appetite, nausea, vomiting, diarrhoea, dizziness, bradycardia, insomnia

Severe alzheimer’s disease

  • Memantine (glutamate receptor antagonist)
34
Q

Memantine

  • class of drug
  • moa
  • side effects
  • effectiveness
A
  • NMDA antagonist
  • blocks glutamate which causes cell damage
  • side effects: constipation, hypertension, dyspnoea, dizziness
    • most effective in treating BPSD
35
Q

dRUGS FOR rteating alcohol dependancy- DAN

A
  • Disulifiram (inhibits alcohol oxidation)
  • Acamprosate (GABA agonist/ glutamate antagonist)
  • Nalmefene- opoid receptor antagonist/ partial agonist
36
Q

Drugs for opioid dependancy

A

buprenorphine- opiod receptor partial agonist

Lofexidine- opiods alpha2 adrenoceptor agonist

methadone- opiod substitute

naltrexone- opioid receptor antagonist

37
Q

drugs to help with nicotine addiction

A

nicotine substitute

varenicline

38
Q

Rapid tranquilisers

4 examples

A

Promethazine IM

Lorazepam IM

Haloperidol IM

Zuclopentixol acetate IM

39
Q

rapid tranquillisers

only used on who (4)

A
  1. detained patients
  2. present a risk to themselves or others
  3. refusing oral medications
  4. for whom de-escalation techniques have been unsuccessful

Used as a last resort

Regular monitoring and full documentation required

40
Q

CNS stimulants and ADHD meds??????????

side effects and monitoring

A

Methylphenidate- ritalin

atomexetine

dexamfetamine

guanfacine

for ADHD causing severe impairment or learning and/ or functioning

in combination w psychological interventions

can affect growth and development- monitoring height and weight required

Cardiovascular effects monitor pulse/ BP

Mental health block (3 decks)

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